Knowledge regarding celiac disease among healthcare professionals,patients and their caregivers in Turkey

BACKGROUND Celiac disease(CD)is one of the most prevalent chronic disorders.The clinical manifestations of CD are diverse and may present with gastrointestinal findings,extra-intestinal findings or no symptoms.Although there has been a marked increase in the prevalence of CD in the past 30 years,up to 95%of patients with CD remain undiagnosed.As most cases have atypical signs or no symptoms,the diagnosis of CD is either missed or delayed.In addition,one of the most important reasons for the delay in diagnosis may be the poor knowledge of healthcare professionals(HCPs)regarding CD.AIM To evaluate the knowledge of HCPs,patients and their caregivers(parents)regarding CD.METHODS The current study was carried out between June 2021 and February 2022 prospectively,as part of the Focus IN CD project.Patients with CD and their caregivers participated in the study from 6 different cities in Turkey.General practitioners,pediatricians,pediatricians with other subspecialities and pediatric gastroenterologists from different cities participated in the study.RESULTS The questionnaire was completed by 348 HCPs,34 patients with CD,and 102 mothers and 34 fathers of patients with CD.Most of the participants were general practitioners(37.07%).There were 89(25.57%)pediatricians and 72(20.69%)pediatric gastroenterologists in the study.The highest score in all categories was achieved by pediatric gastroenterologists.There were significant differences between the four groups of HCPs in terms of the subsections of overall mean score,epidemiology and clinical presentation,treatment and follow-up.No significant difference was found between the groups(patients with CD,mothers of patients with CD and fathers of patients with CD)in terms of the questionnaire subsections.CONCLUSION The level of knowledge on CD among HCPs,patients and their caregivers was unsatisfactory.We consider that it is necessary to increase awareness and to develop e-learning activities on CD among HCPs,patients and their caregivers.Consequently,they may benefit from e-learning programs similar to the one created as part of the EU-funded project Focus IN CD(https://www.celiacfacts.eu/focusincd-en).

Assessment of thiol/disulfide homeostasis for prognostic follow-up of cholangiocarcinoma patients

Background:Cholangiocarcinoma(CCA)is a cancer type that builds in the bile ducts that carry digestive fluid,bile.These ducts connect the liver to the gallbladder and the small intestine.The disease is often diagnosed at an advanced stage,resulting in a low 5-year survival rate.This study aims to evaluate the concentrations of serum thiol/disulfide in CCA patients and healthy volunteers and investigate the association between oxidative activity and clinical and pathological characteristics in CCA patients.By examining the relationship between reduced thiol/disulfide measures and tumorigenesis of the disease,we can potentially identify an unfavourable prognosis in CCA patients.Methods:To assess the status of thiol/disulfide in the blood of Cholangiocarcinoma patients using a novel automated homeostasis assay,we recruited 55 individuals for this study(CCA patients,n=27;healthy volunteers,n=28).We measured the levels of serum total thiol(TT)(–SH+–S-S–),native thiol(NT)(–SH),and disulfide(DD)(–S-S–)in both the CCA group and the control group.Additionally,we calculated the ratio of thiol/disulfide(–SH/–S-S–).Results:We explored the relationship between oxidative activity and clinical and pathological characteristics in CCA patients.The study found no significant differences in age and sex between CCA patients and controls.NT and TT levels were higher in the control group compared to the CCA group.However,the disulfide level did not significantly differ between the two groups.Pearson's correlation matrix analysis revealed positive correlations between TT and NT levels and negative correlations between NT/TT%,DD level,and DD/TT%.Conclusion:Our findings suggest a statistical difference in serum thiol/disulfide parameters.As a marker of total oxidant status,thiol and disulfide levels have decreased in patients with CCA.However,no correlation was found between the tumour markers CEA and CA19-9 and thiol levels.A decrease in blood thiol and disulfide concentrations or the ratio of thiol to disulfide may indicate an increase in oxidative stress and decreased antioxidant capacity.As an indication of the prognosis of cholangiocarcinoma disease in the early period,it may be used to determine the effectiveness of medical interventions.The NT/TT%,disulfide/native thiol percentage,and DD/TT%ratios did not significantly change between the groups.Therefore,measuring serum thiol levels could be a helpful marker for assessing prognosis in the early stages of CCA.Nevertheless,further studies must validate these results and investigate the underlying mechanisms.